Complete Versus Culprit-Only Revascularization in STEMI: a Contemporary Review

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• ST-segment elevation myocardial infarction (STEMI) management prioritizes urgent revascularization of the culprit artery.
• Obstructive non-culprit coronary artery disease is common in STEMI patients and associated with adverse outcomes.
• The optimal strategy for managing non-culprit lesions during STEMI is a subject of ongoing debate.

Purpose of the Study:

• To review the current evidence regarding the management of non-culprit lesions in STEMI.
• To specifically analyze data from randomized clinical trials on this topic.

Main Methods:

• Review of existing literature.
• Focus on randomized controlled trials (RCTs) comparing different revascularization strategies in STEMI.
• Analysis of outcomes based on culprit-only versus complete multivessel revascularization.

Main Results:

• Early observational studies favored culprit-only revascularization.
• Recent RCTs indicate improved patient outcomes with complete multivessel revascularization, performed either during the index procedure or staged.
• These findings have influenced updated STEMI guidelines.

Conclusions:

• Complete multivessel revascularization appears superior to culprit-only revascularization in STEMI patients.
• Despite guideline changes, the precise timing and optimal management strategy for non-culprit lesions in STEMI remain controversial and require further investigation.